Blog | Wednesday, January 15, 2014

QD: News Every Day-- One-third of doctors overuse MRIs for breast cancer screening

More than a third of physicians reported offering MRIs and other breast cancer screening tests that exceeded guidelines for a low-risk 51-year-old woman, a study found.

Guidelines from the U.S. Preventive Services Task Force, the American College of Obstetrics and Gynecology and the American Cancer Society recommend mammography as the only routine screening test for women 50 years and older and who are not at high risk of breast cancer. MRI can be used as an adjunct to mammography for women who face a 20% or greater lifetime risk.

Researchers analyzed 553 family physicians, general internists, and obstetrician-gynecologists who practiced in offices or hospitals. The physicians had completed a survey that presented a vignette of a health maintenance visit for an asymptomatic 51-year-old woman who was not at high risk for breast cancer. The vignettes were randomized to vary the woman’s race, insurance, family history of cancer and request for ovarian cancer screening.

Results appeared in the January issue of the Journal of General Internal Medicine.

In the study, 36% (95 % CI, 31.8 % to 40.5 %) of physicians reported offering breast cancer screening tests that were inconsistent with guidelines, with most offering MRI and/or ultrasound (33.2 %; 95 % CI, 29.1 % to 37.6 %). Adjusted analysis revealed that risk-averse physicians and those who believed in the clinical effectiveness of MRI were more likely to offer extra breast cancer screening.

The researchers noted that one-fifth of women ages 50 to 74 have not received age-appropriate breast cancer screening at all, and they suggested strategies, such as academic detailing and computerized clinical decision support, to decrease overuse of resources.

The authors wrote, “These extra breast cancer screening tests are particularly concerning as there is no evidence of their efficacy for routine screening, and rising U.S. health care costs are, in part, due to the purchase and use of medical technologies.”